As we celebrate this year’s World Women Day, palliative care in Kenya has seen women stand in the practice quite strongly and defending it despite reluctance from policy makers to see its benefit to the ill.

Dr Zipporah Ali is the Executive Director of Kenya Hospices and Palliative Care Association (KEHPCA), an umbrella body of all hospices and palliative care units in the country and she has been vocal, leading the fight for palliative care to be recognized in the country.

Dr. Ali was recently awarded an Honorary Doctorate from Oxford Brookes University in recognition of her internationally acclaimed contribution to palliative care in Africa and her continued work mentoring and supporting students on the programs run in collaboration with the faculty of Health and Life Services at Oxford Brookes. She will be officially receiving this award in June 2013.

Before she sets off to receive her latest achievement in the world of palliative care, she recounts the steps that led her into palliative care and the numerous grounds she has stood to ensure palliative care receives recognition in Kenya.

Kick off

Back in 1980, she left the country to study medicine in Turkey and later her career in palliative care began in 1993 when she volunteered to work at the Nairobi Hospice while undertaking a masters degree at the university of Nairobi.

Dr Ali says that joining Nairobi Hospice was not a coincidence as she had lost her only brother to cancer, and she thought he deserved a better death than that which he suffered.

“Despite the fact that I was a young doctor, I was not able to help my brother who died of cancer as I would have liked. If I only had known then what I know now, with skills, insight and experience acquired over years working with patients and families facing life-threatening illnesses, I would have given him a dignified end of life care.” Dr Ali says.

While at the Hospice she saw colleagues faced with a similar challenge as they attended to patients with terminal illnesses. “I knew that I needed to do something to become a better doctor and help influence other health care providers to become better carers.”

She was subsequently hired to work at the hospice as a medical officer and within no time promoted to be the senior medical officer working with a team comprising of nurses and one social worker.

“I felt truly humbled and encouraged to be part of the team that was providing care to these patients and their loved ones, transforming their lives and those of their families at times of great agony and uncertainty.” Dr Ali says.

While at the hospice, Dr Ali attended several courses on palliative care both in the UK and Kenya. In the UK she met the late Dame Cicely Saunders, founder of the current hospice movement at St. Christopher’s Hospice.

“The late Cicely Saunders talked about the need for palliative care in developing countries and that we should be champions and pioneers, and encourage other health providers by being efficient and effective examples. Even today, her supportive words continue to motivate me to advocate for palliative care.” She says.

In 2001 Oxford Brookes University, in conjunction with Nairobi Hospice, started the first Diploma course in Higher Education in Palliative Care. Dr Ali enrolled in the course and graduated in 2002 with a diploma in palliative care. In many ways, she says that this course, combined with the hands-on experience she had gained empowered her to be a better clinician and carer.

One great achievement for Dr Ali while at the hospice was to convince the medical school at the University of Nairobi to include palliative care training in its undergraduate program. She worked with Dr. Brigid Sirengo, Chief Executive Officer of Nairobi Hospice, writing endless letters to the dean to convince him and his team of the need to integrate palliative care into undergraduate medical training. Eventually they were allocated just two hours in the curriculum which, according to her, was a good start.

The switch

Working in a hospice was limiting in a way to Dr Ali because at that time, the concept of palliative care had not been widely accepted in Kenya and she knew she had to do something about it.

“Like other health care professionals involved in palliative care, I had a bigger dream of seeing palliative care services expand beyond the then-existing 14 service providers to more centers offering much-needed palliative care services.” She says.

In 2006, Dr Ali was given the opportunity to work part time for Kenya Hospices and Palliative Care Association which had not started functioning fully due to lack of funds despite having been registered in 2005.

“In 2007, I was able to secure funding for the association to start up a secretariat, employ staff and start operating as planned. I was appointed the National Coordinator by the board which meant I had to leave the hospice.” Dr Ali says.

She saw her new position at KEHPCA as an opportunity to work with others to advance palliative care in Kenya although she felt sad that she would spend less time in service provision with reduced patient contact.

As a result of the work of dedicated health care providers across the country that share a passion for palliative care and a dream to bring comfort to many who need it, Dr Ali says the number of hospices and palliative care providers in Kenya has risen from 14 in 2007 to over 40 today.

“My experience as a member of the African Palliative Care Association (APCA) board played a big role in preparing me to work in my new position. It was indeed an honor to work with the then board members and the Executive Director of APCA.” She says

“With the World Health Organization “WHO” Public Health Model of palliative care in our minds, we knew we had to work closely with the Ministry of Health to ensure palliative care was introduced successfully across Kenya.” She says.

Integration

Until mid-2010, Dr Ali says palliative care had not been integrated in the Kenyan public health care system except at Kenyatta National Hospital, which is the main referral hospital in Kenya yet most patients in Kenya end up being seen in government hospitals closest to their home areas where there were no palliative care services.

“When working on the recently-launched Kenya National Cancer Control Strategy, I met the Senior Deputy Medical Director in the Ministry of Medical Services, Dr. Izaq Odongo, whom I had last seen in the mid-1990s. Dr. Odongo was ready to listen to what I had to convey about palliative care and health-strengthening systems and how, if palliative care were to be integrated into the public health care system, many patients would benefit and live a better life.”

According to Dr Ali, Dr. William Maina, the former Head of Non Communicable Diseases Department in the Ministry of Public Health and Sanitation, who was facilitating the draft of the national cancer control strategy, was also very keen that palliative care should not be left out. Dr. Maina actually invited KEHPCA to take the lead role on the palliative care strategy and has been supportive since the organization was formed.

Dr Ali says that the current generation of doctors heading government hospitals is young and ready to embrace new knowledge and bring about change in patient care. “Wherever we go, we are received with considerable enthusiasm and eagerness to start palliative care services as early as possible. These young doctors and nurses are the future of palliative care in Kenya. They are the people bringing change. They are the candles that give light to others.” She adds.

KEHPCA, under the leadership of Dr Ali was among ten community-based organizations that received the prestigious Red Ribbon Award for innovative response to AIDS in a special session of the XIX International AIDS Conference (AIDS 2012) on 25th July 2012.

The Red Ribbon Award, which is the world’s leading award for innovative and outstanding community work in the response to the AIDS epidemic, was officially presented to KEHPCA during the World Aids Day celebrations by Kenya’s Vice President Kalonzo Musyoka who said. “This is a very competitive award to bag and having it in Kenya shows the great strides KEHPCA is making towards care for AIDS patients in the country. You have made us proud as a country to be the first organization in Kenya to receive the Red Ribbon Award.”

In collaboration with the Ministry of Medical Services and that of Public Health and Sanitation, Dr Ali says palliative care has successfully been integrated in 11 government Level 5 Hospitals and integration of palliative care to additional 30 Level 4 Hospitals is underway.

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